Skip to main content

Advertisement

SpringerLink
Log in

Intrathecal analgesia for refractory cancer pain

  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

The use of intrathecal analgesics is an important treatment consideration for many patients with chronic cancer pain. This review describes the various opioid and nonopioid analgesics that have been used in this setting, including morphine, hydromorphone, fentanyl, meperidine, methadone, sufentanil, local anesthetics, clonidine, ketamine, baclofen, midazolam, betamethasone, and octreotide. We discuss available evidence for their analgesic and adverse effects.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Krames ES: Intrathecal infusional therapies for intractable pain: patient management guidelines. J Pain Symptom Manage 1993, 8:36–46.

    Article  PubMed  CAS  Google Scholar 

  2. Wang JK, Naus LA, Thomas JE: Pain relief by intrathecally applied morphine in man. Anesthesiology 1979, 50:149–151.

    Article  PubMed  CAS  Google Scholar 

  3. Ventafridda V, Fighuzzi M, Tamburini M, et al.: Clinical observation on analgesia elicited by intrathecal morphine in cancer patients. In Advances in Pain Research and Therapy, vol 2. Edited by Bonica JJ, Ventafridda V. New York: Raven Press; 1979:559–565.

    Google Scholar 

  4. Lubenow TR, Ivankovich AD: Intraspinal narcotics for treatment of cancer pain. Semin Surg Oncol 1990, 6:173–176.

    Article  PubMed  CAS  Google Scholar 

  5. Arnér S, Arnér B: Differential effects of epidural morphine in the treatment of cancer-related pain. Acta Anaesthesiol Scand 1985, 29:32–36.

    PubMed  Google Scholar 

  6. Mercadante S: Problems of long-term spinal opioid treatment in advanced cancer patients. Pain 1999, 79:1–13.

    Article  PubMed  CAS  Google Scholar 

  7. Mercadante S: Neuraxial techniques for cancer pain: an opinion about unresolved therapeutic dilemmas. Reg Anesth Pain Med 1999, 24:74–83.

    Article  PubMed  CAS  Google Scholar 

  8. Wagemans MF, Zuurmond WW, de Lange JJ: Long-term spinal opioid therapy in terminally ill cancer pain patients. Oncologist 1997, 2:70–75.

    PubMed  CAS  Google Scholar 

  9. Akahoshi MP, Furuike-McLaughlin T, Enriquez NC: Patient controlled analgesia via intrathecal catheter in outpatient oncology patients. J Intraven Nurs 1988, 11:289–292.

    PubMed  CAS  Google Scholar 

  10. Hardy PA, Wells JC: Patient-controlled intrathecal morphine for cancer pain. A method used to assess morphine requirements and bolus doses. Clin J Pain 1990, 6:57–59.

    Article  PubMed  CAS  Google Scholar 

  11. Onofrio BM, Yaksh TL: Long-term pain relief produced by intrathecal morphine infusion in 53 patients. J Neurosurg 1990, 72:200–209.

    PubMed  CAS  Google Scholar 

  12. Schultheiss R, Schramm J, Neidhardt J: Dose changes in long-and medium-term intrathecal morphine therapy of cancer pain. Neurosurgery 1992, 31:664–669.

    Article  PubMed  CAS  Google Scholar 

  13. Devulder J, Ghys L, Dhondt W, Rolly G: Spinal analgesia in terminal care: risk versus benefit. J Pain Symptom Manage 1994, 9:75–81.

    Article  PubMed  CAS  Google Scholar 

  14. Chambers FA, MacSullivan R: Intrathecal morphine in the treatment of chronic intractable pain. Ir J Med Sci 1994, 163:318–321.

    Article  PubMed  CAS  Google Scholar 

  15. Paice JA, Penn RD, Shott S: Intraspinal morphine for chronic pain: a retrospective, multicenter study. J Pain Symptom Manage 1996, 11:71–80.

    Article  PubMed  CAS  Google Scholar 

  16. Wen YR, Hou WY, Chen YA, et al.: Intrathecal morphine for neuropathic pain in a pregnant cancer patient. J Formos Med Assoc 1996, 95:252–254.

    PubMed  CAS  Google Scholar 

  17. Gilmer-Hill HS, Boggan JE, Smith KA, et al.: Intrathecal morphine delivered via subcutaneous pump for intractable pain in pancreatic cancer. Surg Neurol 1999, 51:6–11.

    Article  PubMed  CAS  Google Scholar 

  18. Sloan PA: Neuraxial pain relief for intractable cancer pain. Curr Pain Headache Rep 2007, 11:283–289.

    Article  PubMed  Google Scholar 

  19. Vranken JH, van der Vegt MH, van Kan HJ, Kruis MR: Plasma concentrations of meperidine and normeperidine following continuous intrathecal meperidine in patients with neuropathic cancer pain. Acta Anaesthesiol Scand 2005, 49:665–670.

    Article  PubMed  CAS  Google Scholar 

  20. Brogan SE: Intrathecal therapy for the management of cancer pain. Curr Pain Headache Rep 2006, 10:254–259.

    Article  PubMed  Google Scholar 

  21. Osenbach RK, Harvey S: Neuraxial infusion in patients with chronic intractable cancer and noncancer pain. Curr Pain Headache Rep 2001, 5:241–249.

    Article  PubMed  CAS  Google Scholar 

  22. Kedlaya D, Reynolds L, Waldman S: Epidural and intrathecal analgesia for cancer pain. Best Pract Res Clin Anaesthesiol 2002, 16:651–665.

    Article  PubMed  Google Scholar 

  23. Wilson GR, Reisfield GM: Morphine hyperalgesia: a case report. Am J Hosp Palliat Care 2003, 20:459–461.

    Article  PubMed  Google Scholar 

  24. Paice JA, Winkelmüller W, Burchiel K, et al.: Clinical realities and economic considerations: efficacy of intrathecal pain therapy. J Pain Symptom Manage 1997, 14(Suppl 3):S14–S26.

    Article  PubMed  CAS  Google Scholar 

  25. Coyne PJ, Smith T, Laird J, et al.: Effectively starting and titrating intrathecal analgesic therapy in patients with refractory cancer pain. Clin J Oncol Nurs 2005, 9:581–583.

    Article  PubMed  Google Scholar 

  26. van Dongen RT, Crul BJ, van Egmond J: Intrathecal coadministration of bupivacaine diminishes morphine dose progression during long-term intrathecal infusion in cancer patients. Clin J Pain 1999, 15:166–172.

    Article  PubMed  Google Scholar 

  27. Nitescu P, Appelgren L, Linder LE, et al.: Epidural versus intrathecal morphine-bupivacaine: assessment of consecutive treatments in advanced cancer pain. J Pain Symptom Manage 1990, 5:18–26.

    Article  PubMed  CAS  Google Scholar 

  28. Mercadante S, Intravaia G, Villari P, et al.: Intrathecal treatment in cancer patients unresponsive to multiple trials of systemic opioids. Clin J Pain 2007, 23:793–798.

    PubMed  Google Scholar 

  29. Baker L, Lee M, Regnard C, et al.: Evolving spinal analgesia practice in palliative care. Palliat Med 2004, 18:507–515.

    Article  PubMed  Google Scholar 

  30. Goucke R: Continuous intrathecal analgesia with opioid/local anaesthetic mixture for cancer pain. Anaesth Intensive Care 1993, 21:222–223.

    PubMed  CAS  Google Scholar 

  31. Mercadante S, Calderone L, Barresi L: Intrathecal ropivacaine in cancer pain. Reg Anesth Pain Med 1998, 23:621.

    Article  PubMed  CAS  Google Scholar 

  32. Kshatri AM, McGarrity SJ, Hahn MB: Patient-controlled analgesia using ropivacaine via an intrathecal catheter. Reg Anesth Pain Med 1998, 23:320–322.

    Article  PubMed  CAS  Google Scholar 

  33. Tumber PS, Fitzgibbon DR: The control of severe cancer pain by continuous intrathecal infusion and patient controlled intrathecal analgesia with morphine, bupivacaine and clonidine. Pain 1998, 78:217–220.

    Article  PubMed  CAS  Google Scholar 

  34. De Kock M, Lavand’homme P, Waterloos H: The shortlasting analgesia and long-term antihyperalgesic effect of intrathecal clonidine in patients undergoing colonic surgery. Anesth Analg 2005, 101:566–572.

    Article  PubMed  Google Scholar 

  35. Ugur F, Gulcu N, Boyaci A: Intrathecal infusion therapy with dexmedetomidine-supplemented morphine in cancer pain. Acta Anaesthesiol Scand 2007, 51:388.

    Article  PubMed  CAS  Google Scholar 

  36. Yang CY, Wong CS, Chang JY, Ho ST: Intrathecal ketamine reduces morphine requirements in patients with terminal cancer pain. Can J Anaesth 1996, 43:379–383.

    PubMed  CAS  Google Scholar 

  37. Vranken JH, van der Vegt MH, Kal JE, Kruis MR: Treatment of neuropathic cancer pain with continuous intrathecal administration of S+-ketamine. Acta Anaesthesiol Scand 2004, 48:249–252.

    Article  PubMed  CAS  Google Scholar 

  38. Karpinski N, Dunn J, Hansen L, Masliah E: Subpial vacuolar myelopathy after intrathecal ketamine: report of a case. Pain 1997, 73:103–105.

    Article  PubMed  CAS  Google Scholar 

  39. Staats PS, Yearwood T, Charapata SG, et al.: Intrathecal ziconotide in the treatment of refractory pain in patients with cancer or AIDS: a randomized controlled trial. JAMA 2004, 29:63–70.

    Article  Google Scholar 

  40. Hanna MH, Peat SJ, Woodham M, et al.: Analgesic efficacy and CSF pharmacokinetics of intrathecal morphine-6-glucoronide: comparison with morphine. Br J Anaesth 1990, 64:547–550.

    Article  PubMed  CAS  Google Scholar 

  41. Dennis GC, Soni D, Dehkordi O, et al.: Analgesic responses to intrathecal morphine in relation to CSF concentrations of morphine-3,beta-glucuronide and morphine-6,beta-glucuronide. Life Sci 1999, 64:1725–1731.

    Article  PubMed  CAS  Google Scholar 

  42. Mercadante S, Arcuri E, Ferrera P, et al.: Alternate treatments of breakthrough pain in patients receiving spinal analgesics for cancer pain. J Pain Symptom Manage 2005, 30:485–491.

    Article  PubMed  CAS  Google Scholar 

  43. Taguchi H, Shingu K, Okuda H, et al.: Analgesia for pelvic and perineal cancer pain by intrathecal steroid injection. Acta Anaesthesiol Scand 2002, 46:190–193.

    PubMed  CAS  Google Scholar 

  44. Taguchi H, Oishi K, Sakamoto S, et al.: Intrathecal betamethasone for cancer pains in the lower half of the body: a study of its analgesic efficacy and safety. Br J Anaesth 2007, 98:385–389.

    Article  PubMed  CAS  Google Scholar 

  45. Mollenholt P, Rawal N, Gordh T Jr, et al.: Intrathecal and epidural somatostatin for patients with cancer. Analgesic effects and postmortem neuropathologic investigations of spinal cord and nerve roots. Anesthesiology 1994, 81:534–542.

    Article  PubMed  CAS  Google Scholar 

  46. Paice JA, Penn RD, Kroin JS: Intrathecal octreotide for relief of intractable nonmalignant pain: 5-year experience. Neurosurgery 1996, 38:203–207.

    Article  PubMed  CAS  Google Scholar 

  47. Galloway K, Staats PS, Bowers DC: Intrathecal analgesia in children with cancer via implanted infusion pumps. Med Pediatr Oncol 2000, 34:265–267.

    Article  PubMed  CAS  Google Scholar 

  48. Lazorthes Y, Bles JC, Sagen J, et al.: Transplantation of human chromaffin cells for control of intractable cancer pain. Acta Neurochir 1995, 64(Suppl):97–100.

    CAS  Google Scholar 

  49. Mathews GJ, Pace-Floridia A: Intrathecal cold saline for the relief of intractable pain. Can Med Assoc J 1970, 103:1143–1146.

    Google Scholar 

  50. Savitz MH, Malis LI: Intractable pain treated with intrathecal isotonic iced saline. J Neurol Neurosurg Psychiatry 1973, 36:417–420.

    PubMed  CAS  Google Scholar 

  51. Wong CS, Chang YC, Yeh CC, et al.: Loss of intrathecal morphine analgesia in terminal cancer patients is associated with high levels of excitatory amino acids in the CSF. Can J Anesth 2002, 49:561–565.

    Article  PubMed  Google Scholar 

  52. Appelgren L, Nordborg C, Sjoberg M, et al.: Spinal epidural metastasis: implications for spinal analgesia to treat “refractory” cancer pain. J Pain Symptom Manage 1997, 13:25–42.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Albany Medical College, Albany, USA

    Charles E. Argoff

  2. Comprehensive Pain Program, The Neurosciences Institute, Albany Medical Center, 47 New Scotland Avenue, MC-70, Albany, NY, 12208, USA

    Charles E. Argoff

Authors
  1. Scott Newsome
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bridget K. Frawley
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Charles E. Argoff
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Charles E. Argoff.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Newsome, S., Frawley, B.K. & Argoff, C.E. Intrathecal analgesia for refractory cancer pain. Current Science Inc 12, 249–256 (2008). https://doi.org/10.1007/s11916-008-0043-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11916-008-0043-0

Keywords

Search

Navigation